Prevalence of Cardiovascular Risk Factors and Strokes in Younger Adults

Abstract

IMPORTANCE While stroke mortality rates have decreased substantially in the past 2 decades, this trend has been primarily limited to older adults. Increasing trends in stroke incidence and hospitalizations have been noted among younger adults, but there has been concern that this reflected improved diagnosis through an increased use of imaging rather than representing a real increase.OBJECTIVES To determine whether stroke hospitalization rates have continued to increase and to identify the prevalence of associated stroke risk factors among younger adults. DESIGN, SETTING, AND PARTICIPANTS Hospitalization data from the National Inpatient Sample from 1995 through 2012 were used to analyze acute stroke hospitalization rates among adults aged 18 to 64 years. Hospitalization data from 2003 to 2012 were used to identify the prevalence of associated risk factors for acute stroke. Acute stroke hospitalizations were identified by the principal International Classification of Diseases, Ninth Revision, Clinical Modification code and associated risk factors were identified by secondary International Classification of Diseases, Ninth Revision, Clinical Modification codes for each hospitalization. MAIN OUTCOMES AND MEASURES Trends in acute stroke hospitalization rates by stroke type, age, sex, and race/ethnicity, as well as the prevalence of associated risk factors by stroke type, age, and sex. RESULTS The 2003-2004 set included 362 339 hospitalizations and the 2011-2012 set included 421 815 hospitalizations.The major findings in this study are as follows: first, acute ischemic stroke hospitalization rates increased significantly for both men and women and for certain race/ethnic groups among younger adults aged 18 to 54 years; they have almost doubled for men aged 18 to 34 and 35 to 44 years since 1995-1996, with a 41.5% increase among men aged 35 to 44 years from 2003-2004 to 2011-2012. Second, the prevalence of stroke risk factors among those hospitalized for acute ischemic stroke continued to increase from 2003-2004 through 2011-2012 for both men and women aged 18 to 64 years (range of absolute increase: hypertension, 4%-11%; lipid disorders, 12%-21%; diabetes, 4%-7%; tobacco use, 5%-16%; and obesity, 4%-9%). Third, the prevalence of having 3 to 5 risk factors increased from 2003-2004 through 2011-2012 (men: from 9% to 16% at 18-34 years, 19% to 35% at 35-44 years, 24% to 44% at 45-54 years, and 26% to 46% at 55-64 years; women: 6% to 13% at 18-34 years, 15% to 32% at 35-44 years, 25% to 44% at 45-54 years, and 27% to 48% at 55-65 years; P for trend < .001). Finally, hospitalization rates for intracerebral hemorrhage and subarachnoid hemorrhage remained stable, with the exception of declines among men and non-Hispanic black patients aged 45 to 54 with subarachnoid hemorrhage (13.

Influenza‐like illness as a trigger for ischemic stroke

“…We found that younger patients were at relatively increased odds of stroke after ILI compared to older patients; for every decade younger age, the odds increased by almost 10%. While the absolute risk of stroke is greater in older adults, approximately 10–14% of all strokes occur in people 18–45 years old, with the incidence and prevalence of stroke in the young increasing 4, 28, 29, 30, 31, 32, 33, 34. This increasing prevalence, moreover, coupled with greater heterogeneity in stroke etiology within the younger age group than in the older stroke population, presents a unique and vulnerable patient population where risk reduction efforts are of increasing importance.…”

“…Conventional risk factors such as hypertension, diabetes, sedentary behavior, and smoking account for almost 80% of stroke risk, leaving a substantial proportion of stroke risk unexplained 4. In addition, conventional risk factors are primarily associated with long‐term risk and do not explain why individuals have strokes at one particular point in time rather than at another time.…”

Prevalence of obesity among stroke patients in five Brazilian cities: a cross-sectional study

“…As expected, these findings have an impact on the stroke burden. A recent survey compared 362,339 stroke hospitalizations in 2003-2004 to 421,815 hospitalizations in 2011-2012 in the EUA, and found an absolute increase from 4% to 9% in the prevalence of obesity in among adults aged 18-64 years 20 . In a previous population-based study conducted in Joinville, we found that 16% (95%CI 14-19) of 601 patients with first-ever ischemic stroke were obese in the 2005-2006 period.…”

“…Our findings were similar to a Finland cohort 22 but higher than those from Germany and China 23,24,25,26,27 . The causality between obesity and stroke is debatable 18,19,20 . A meta-analysis of 21 cohort studies reported that risk of ischemic stroke was 22% in patients who were overweight and 64% among those who were obese.…”

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

“…Although costs for younger populations may be relatively low, they likely need care over a longer period of time, for the remainder of their lives for some patients. Stroke is also occurring at earlier ages in young adults 79 ; thus, further consideration of these caregiving needs is warranted.…”